Rejection in patients with simultaneous pancreas-$$$kidney transplants- an immunologic Pas de Deux

chronic hyponatremia without neurologic impairment, slow increase of 4-6 mmol/L in a 24-hour period is preferred to avoid osmotic demyelination syndrome.Conclusion: Our patient displayed multifactorial etiology for hyponatremia.She had a history of chronic hyponatremia stemming from HCTZ use and undiagnosed liver cirrhosis.But aggravation of hyponatremia to the range of 98 mmol/L was likely due to added gastrointestinal and cutaneous losses with excessive water consumption.Also, SIADH from hospital acquired pneumonia triggered a recurrence of hyponatremia.Cautious management cannot be overstated to avoid neurologic complications.